Diagnosis: Often Clinical (Characteristic symptoms, and a good response to emperic treatment with anti-histamines or nasal corticosteroids)

Formal diagnosis is based on evidence of sensitization, measured either by the presence of allergen-specific IgE in the serum or by positive epicutaneous skin tests (i.e., wheal and flare responses to allergen extracts) and a history of symptoms that correspond with exposure to the sensitizing allergen. It is easier to diagnose the disease when seasonal symptoms are present or when the pa- tient can clearly identify a single trigger than when symptoms are chronic or the patient reports more than one trigger, including allergens and irritants. Epicutaneous skin testing and test- ing for allergen-specific IgE have similar sensitivity, although they do not identify sensitization in an entirely overlapping group of patients.20 NEJM 2015

Definite Severity:

Moderate to Severe (presence of one or more of the following):

Sleep Disturbance

Impairment of Usual activities or exercise

Impairment of School or Work Performance

Troublesome Symptoms

Differential Diagnosis:

Non-allergic (noninflammatory) rhinopathy aka Vasomotor Rhinitis

NAR is about 50% of all cases of Rhinitis

Negative Serum IgE and Skin Testing (50 % of these patient have local nasal allergic rhinitis limited to nasal mucosa)

Non-allergic Chronic Rhinosinusitis

Mixed Rhinitis (Allergic Rhinitis + nonallergic Rhinitis)

NAR in these cases could be a state of nasal hyper responsiveness due to AR